My name is Patrik Hutzel from intensivecarehotline.com, where we instantly improve the lives for families of critically ill patients in intensive care, so that you can make informed decisions, have peace of mind, control, power, and influence, even if you’re not a doctor or a nurse in intensive care, so making sure that your loved one always gets best care and treatment.

So, today I have an email from one of our clients, DC who says,

“Hi Patrik,

I saw my mother this morning in ICU.

She was responsive to me, and it was nice to see her. She was shaking from high sodium levels.

Please check the metabolic panel. This is a client where we have access to the medical records and we help them interpret everything that’s happening.

We leave no stone unturned and explain everything into detail with them so that they’re well-armed when dealing with intensive care teams, and you will see in a minute why this is so important.

So, the email continues.

This high sodium level was a concern as I was not at the bedside to catch this issue from the 2 days before. She also shows sign of infection, perhaps low-grade fever, and she was sneezing. These sneezes suggest a sinus infection, she’s got a history of it. No antibiotics are being given and her immature gram stain count is spiking, which usually points to an infection starting in her sinuses.

The nurse suctioned her mouth and there was a lot of secretions in the oral cavity but not much in the endotracheal tube. No CBC, complete blood count, no CMP, comprehensive metabolic panel was done.

Something’s not right.

These labs are always drawn, and the last white cell count was trending higher, as well as differential numbers being higher. My mother was sneezing and an infection was brewing, yet no labs were done today.

The nurse said they’re planning something. It looks like they want to remove life support and stop treatment. Are they beginning to withdraw treatment?

My mom is full code and entitled to being reintubated if that need were to arise. My mom clearly requires IV antibiotics and regular suctioning around the clock care.

What to do now is the question, what do you propose?
From DC”.

And just as a side note, you know, DC mentioned that she can’t be always at the bedside and that’s quite usual for families that they can’t be there 24/7, even though they want to be there 24/7, of course, but life has to go on.

And that’s when it’s so important that you do have access to the medical records and you have Intensive Care Hotline here help you to interpret everything that’s in the medical records.

Because, as a layperson that hasn’t worked in intensive care for decades like we have, you wouldn’t know what to look for.

So, DC thank you for reaching out and I’m so glad you were able to see your mother this morning and that she was responsive to you. That’s always a positive sign even when there are concerning developments happening around her care.

Now let me address your very legitimate concerns about what appears to be a potential. Withdrawal of treatment or at the very least a troubling gap in standard ICU care for your mother.

So, you’ve identified a very concerning pattern. You’ve picked up on something that many families, I would argue 99% of families in intensive care miss. This is exactly why having someone at the bedside who understands ICU care is absolutely critical, or having someone walking with you that understands intensive care inside out is absolutely critical.

So let me break this down, what you’re seeing. Let’s look at the clinical red flags.

Your mother is showing multiple signs that warrant close monitoring and intervention, the high sodium causing shaking, the sneezing suggesting a sinus infection, especially with her history, the elevated immature granulocyte count, the trending upward white cell count, and increased secretions in her oral cavity all point to an infection that needs to be addressed aggressively.

Now let’s look at the care gap that is alarming.
What’s deeply concerning is the sudden absence of basic ICU labs, you’re absolutely right, complete blood count, metabolic panel are standard daily labs in ICU, especially for critically ill patients, with the clinical picture you are describing.

When these routine labs suddenly stop being drawn, it raises serious questions about the treatment plan and about the level of care your mother is getting, or more importantly, not getting.

That leads to the next question.
As you’ve highlighted, is the ICU team withdrawing treatment? Based on what you’re describing, there are several possibilities.

First possibility, passive withdrawal. Sometimes ICU teams begin what I call a passive withdrawal, where they stop doing routine monitoring and interventions without explicitly discussing withdrawal of life support with the family, and this is very problematic because your mother is full code, which means she’s entitled to full aggressive treatment, including reintubation if needed.

But also, your mother is awake, have they asked your mother? If they haven’t asked your mother, they are going behind your mother’s back. They don’t bother talking to patients or families, which is very concerning. They think they know it all and they think they don’t need to talk to patients or families, that is extremely concerning, and it’s a sign of a poorly managed ICU.

I bet they have a high staff turnover, they have low staff morale.

I worked in ICU for over 25 years. I’ve seen all of that, possibility too, miscommunication or planning. The nurse, your mother’s nurse mentioned they are planning something. This vague statement needs immediate clarification.

Are they planning extubation? Are they planning a tracheostomy? Are they planning a family meeting to discuss goals of care? You need clarification and concrete answers.

Let’s look at the 3rd possibility, inadequate care. It’s possible the ICU team has simply dropped the ball on ordering routine labs and treating what appears to be an emerging infection. This can happen unfortunately, but it is unacceptable.

So, what do you need to do right now?

First off, demand immediate clarification.

You need to speak with the attending doctors, ICU teams today and ask these following direct questions. Why were routine labs, full blood count, and metabolic panel not ordered today? What is the treatment plan for the signs of infection my mother is showing? Why are antibiotics not being started given the elevated white blood cell count, elevated immature granulocyte count, and clinical signs of infection? What exactly are you planning for my mother? Is there any discussion of withdrawing or limiting treatment? That hasn’t been discussed with me, and if so, why wasn’t I informed?

Number 2. Reassert your mother’s code status.

Make it crystal clear that your mother is full code and you expect full aggressive treatment. That means starting antibiotics if infection is suspected. Drawing routine daily labs, full blood count, metabolic panel, blood cultures if indicated, regular suctioning to prevent aspiration and pneumonia. Addressing metabolic abnormalities like the high sodium, potassium for example, or magnesium, continuing all life sustaining treatments. And ask them to talk to your mother directly while you are there and not undermining a patient.

Third, request access to all medical records.
This is absolutely critical, DC. You need immediate access to all medical records, including all lab results from admission to present, all imaging reports, all doctors, nurses’ notes. All medication administration records, the current treatment planning orders, all ventilation orders, ventilation settings. Fluid balance charts and the list goes on.

These medical records in ICU will show you exactly what’s being done or not being done, and it will help identify patterns that the ICU team might not be disclosing to you. And here’s how intensivecarehotline.com can help you right now.

DC, this is exactly the type of situation where a consulting call with myself or with one of my team members will be game changing. Here’s what we can do, we review all medical records.

Once you have access to all medical records, we review them with you and identify gaps in treatment concerning trends in lapse or vital signs, whether the current management is appropriate, what questions you need to ask. What interventions should be happening? We can also join you for rounds or family meetings.
We participate in consulting calls with you and the ICU team. This means we can question the treatment plan directly in real time.

We will advocate for your mother’s care. We clarify confusing medical information or medical jargon. We push back on inappropriate withdrawal of treatment.

With hospital policy knowledge, law knowledge, because they can’t just do that, it’s illegal.

We ensure that your mother gets the care she’s entitled to as a full code patient. We will also develop a strategic plan based on your mother’s specific situation.

We help you develop a strategic plan that includes what treatments need to happen immediately, how to advocate effectively with this ICU team, when to escalate concerns to hospital administration, whether a hospital transfer might be appropriate, what the long-term options are for your mother.

Let’s also look at the infection needs and the immediate treatment that can be done. Let me be very clear about something, your mother is showing multiple signs of infection, and infections in ICU patients can deteriorate rapidly.

The combination of elevated and trending white blood cell count, elevated immature granulocyte count, which suggests the bone marrow is responding to infection, clinical signs like sneezing, sinus infection, increased oral secretions.

This clinical picture demands immediate broad spectrum IV antibiotics while cultures are pending. The fact that antibiotics haven’t been started is a significant gap in care that needs to be addressed immediately.

The high sodium also needs correction as hypernatremia, high sodium, can cause neurological symptoms like the shaking you observed and can complicate her overall condition.

Your mother’s code status matters.

I want to emphasize something crucial, full code means full code. Your mother is entitled to full resuscitation if her heart stops, reintubation if she’s extubated and can’t breathe, all necessary medical treatments including antibiotics, IV fluids, vasopressors, inotropes, and so forth, routine monitoring and labs, aggressive treatment if any complications, a tracheostomy if she can’t be extubated.

If the ICU team is uncomfortable continuing aggressive treatment, they need to have an explicit conversation with you about goals of care. They cannot simply stop providing standard ICU care without your knowledge and consent. Let’s also look at long-term options now.

DC, I also want you to be aware of long-term options. If it turns out your mother needs prolonged ventilation or a tracheostomy, this is where intensivecareathome.com becomes relevant.

So, have a look at intensivecareathome.com. It’s a better long-term solution.

If your mother requires long-term ventilation and or a tracheostomy, Intensive Care at Home can help you keep her out of ICU predictably and permanently.

Here is why this matters.

Better quality of life, of course, instead of being in an ICU or an ICU stuck long-term. Where you’re dealing with situations like what you’re experiencing now, missed labs, potential gaps in care, being unable to be, bedside 24/7.

Your mother could be at home with around the clock ICU level nursing care with critical care registered nurses. You and your family are present whenever you want, a familiar, comfortable environment, control over her care and treatment decisions. Better prevention of hospital acquired infections, because a home environment is a clean environment.

It’s a comprehensive care option because Intensive Care at Home provides long-term mechanical ventilation at home, tracheostomy care at home with or without ventilation, all the suctioning and airway management your mother needs, IV antibiotics, potassium, IV magnesium, TPN (Total Parenteral Nutrition), and any other IV medications she might need. Full medical monitoring, even end of life care if that becomes the only option. Though it looks like that’s not the only option from what you’re sharing with us and it’s important that you can keep your mother out of ICU permanently and predictably.

The goal would be to stabilize your mother, get her through this current crisis, and then transition her to home-based intensive care if she needs long-term ventilation and tracheostomy, where she gets consistent care with a regular team, not people who are coming and going, and where she’s not subject to the kind of care gaps you’re seeing right now.

Let’s look at the immediate action plan. Here’s what I propose you do right now, DC.

Today, request an immediate meeting with the attending ICU team. Demand answers to the questions I outlined above, reassert your mother’s full code status in writing. Request all medical records immediately, and just as a side note, getting access to the medical records is a right, not a privilege.

I can’t stress enough how important it is for you to get access to the medical records, and if the ICU team is putting obstacles in your way to get access to the medical records, which is your right, you need to ask yourself, what do they have to hide, what is it you can’t see?

Insist that routine labs, full blood count, metabolic panel, arterial blood gas (ABGs), etc., are drawn today and every day. Push for antibiotics to be started given the clinical picture, request blood cultures if not already done.

Within the next 24 hours, call intensivecarehotline.com and book a consulting call with me. Have all medical records ready for us to review. Schedule a consulting call and I can join you and the ICU team and put pressure on and develop a comprehensive advocacy and treatment plan.

For long-term planning, contact intensivecarehotline.com to discuss long-term options at home if your mother needs prolonged ventilation and tracheostomy and understand the full range of care options, available. Don’t act, don’t wait. Act now and, and do all the things that we discussed in this video.

And if you are in a similar situation and you’re struggling to get answers from the ICU team, or do you feel like treatment is being withdrawn prematurely and without your consent, subscribe, subscribe to my YouTube channel for more ICU strategies.

Visit intensivecarehotline.com and subscribe to my email newsletter there for consultation services and check out intensivecareathome.com for long-term.

For long-term solutions for long-term ICU patients to keep your loved one out of ICU permanently and predictably.

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over 5 years in intensive care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting and advocacy because of our insights. You can verify that on our testimonial section at intensivecarehotline.com. You can verify it on our intensivecarehotline.com podcast section where we have done client interviews because our advice is absolutely life changing.

The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care.

That’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment always. That’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives.

That’s why I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you simply cannot afford to get wrong. When I talk to families directly, I also talk to doctors and nurses directly, asking all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.

I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care if in case you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care, and you can become a member if you go to intensivecarehotline.com, if you click on the membership link, or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email, and we answer all questions intensive care related. In the membership, you also have exclusive access to 21 eBooks and 21 videos that I have personally written and recorded. All of that will help you to improve your life instantly, make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets best care and treatment always.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care. Click the like button, click the notification bell, share the video with your friends and families, and comment below what you want to see next, what questions and insights you have from this video.

I also do a weekly YouTube live where I answer your questions live on the show. You will get notification for the YouTube live if you are a subscriber to my YouTube channel or my intensivecarehotline.com email newsletter at intensivecarehotline.com.

Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.